Last week, NHS England published an update to the Five Year Forward View. In terms of elective care, the following was of interest:
- GP referral growth has slowed to a modest 1.6% year-to-date
- NHS England will work with upper quartile higher referring GP practices and CCGs to benchmark clinical appropriateness of hospital referrals using CCG dashboards and a new tool from NHS Digital, and then deploy clinical peer review.
- CCGs will review their referral management processes and guidance, where appropriate redesigning patient pathways for example to allow speedier access to physiotherapy for musculoskeletal patients with back pain.
- By summer of 2017 GPs will be able electronically to seek advice and guidance from a hospital specialist without the patient needing an outpatient appointment.
- The Getting It Right First Time initiative will work direct with consultants on the appropriateness of certain procedures of questionable clinical value such as some spinal surgery procedures.
As usual, a lot of interesting commentary in the media.
The Independent led on the fact that the 18 week target has been “jettisoned”. But there won’t be as much need for patients to go to hospitals as hundreds of thousands of patients would no longer be referred to a consultant by their GP. Instead, GPs will be able to phone consultants to ask for advice, while other measures will be put in place to cut the number of people needing to be sent to hospital for care.
Simon Stevens was quoted as saying that there is a “big variation between individual GP practices in different parts of the country” when it [comes] to referrals, although referral rates more broadly have been lowered.
He said patients did not all need to go to hospital, adding: “It’s clearly going to be hundreds of thousands of patients at least for whom better alternatives which don’t involve being sent off to the outpatient department will be put in place.”
The Guardian reflected the Royal College of Surgeon’s feeling that the government was “waving the white flag”. Chris Hopson, the chief executive of NHS providers, presumably felt the pressure dropping as the 18 week target was dropped. He welcomed Simon Stevens’s move as proof of “greater realism” among NHS bosses. “But we do need to remember the impact on patients. The [NHS] plan reinforces a simple, stark truth: that you get what you pay for,” said Hopson.
The threat of rationed care was also recognised: GPs will be expected to refer fewer people to hospital and instead arrange treatment in the community. NHS England will expand the use of “referral management processes”, under which doctors assess whether patients need to go to hospital at all.
The Times (paywall) noted that, although Ministers have agreed the plan, they remain willing to step in if waiting lists mushroom. Underpinning this political reality was the fact that Simon Stevens is clearly on the naughty step at 10 Downing Street. Tensions over NHS funding became public in January when [he] rebuked the prime minister for saying that the £8 billion a year extra promised by 2020 was more than he had asked for. He pointed out that population rises are about to outstrip cash increases and blamed cuts to social care for overwhelming hospitals.